Concluded Case

Volvulus

Patient came with complaints of vomitings, constipation and abdominal distension since five days Exploratory laparatomy shows the above pic Suggest wether it's better to go for diversion ileostomy or only resection and anastomoses of colon?

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Concluded answer

Go for ileostomy for sure,condition of colon is worse and obviously whole gut would be in bad condition so jst go for temporary proximal ileostomy wid resection anastomosis or u may go with double barrel colostony if condition is better.

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The visible portion of colon is gangrenous. It looks like sigmoid volvulus. Decision for diversion ileostomy depends upon - whether enough viable portion of colon is available for resection anastomosis or not . If available- resection anastomosis and strict NPO , RT suction, IV fluids for at least 5 days is required along with Piperacillin 4 gm + tazobactum 500 mg × 6 hourly . If available colon- not available for resection anastomosis- then diversion ileostomy is indicated

After laparotomy wheather to go for diversion ileostomy or resection anastomosis . It depends on the cause of obstruction , general condition of the patient. It is a safe game to play to go for diversion ileostomy irrespective of cause and condition of the patient because the gut condition remains vulnarable for infection . After resuscitation of the pt and improving the general condition next step of repair can be planned.

Thanks Dr Varinder Kumar
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Intestinal obstruction secondary to volvulus . Resection of the gangrenous segment and end to end anastomoses followed by a good peritoneal toilet . Surgical drain in the flanks . Iv fluids ,antibiotics.analgesics ,nasogastric aspiration.

Resection anastomosis decided upon the patient’s general condition... on table surgeon is the best to judge it.. Better to go for resection anastomosis with diversion Ileostomy...

Depends on available viable gut but I am in favour of going for diversion ileostomy because of no scope for gut preparation.
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It seems like sigmoid volvulus.the gangrenous bowel needs excision.if the general condition of pt is poor end colostomy can be done and then anastomosis at a later date.

Intestinal obstruction Colon seen is gangrenous Yes diversion ileostomy is preferred

Go for ileostomy for sure,condition of colon is worse and obviously whole gut would be in bad condition so jst go for temporary proximal ileostomy wid resection anastomosis or u may go with double barrel colostony if condition is better.

I agree
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I think should go for diversion ileostomy

I intestine gangrenous due to intestinal obstructions. Adv.iliostomy

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